British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Pretreatment with alfentanil reduces pain caused by propofol.
We have compared two groups (n = 22) of unpremedicated patients to determine if the pain caused by injection of propofol could be modified by alfentanil. In group I, alfentanil 1 mg was given as a bolus i.v. injection 15 s before administration of propofol i.v., while group II received saline. ⋯ All injections were given through the same i.v. cannula on the dorsum of one hand. We found that alfentanil pretreatment reduced pain on injection of propofol (P = 0.001).
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Randomized Controlled Trial Comparative Study Clinical Trial
Effects of isoflurane-nitrous oxide and halothane-nitrous oxide anaesthesia on myocardial contractility assessed by transoesophageal echocardiography.
In order to evaluate the direct effect of isoflurane-nitrous oxide and halothane-nitrous oxide anaesthesia on cardiac contractility in 20 adults, we have used a method based on left ventricular end-systolic wall stress (LVESWS) vs velocity of circumferential fibre shortening with corrected heart rate (Vcfc), obtained by transoesophageal echocardiography. We found that LVESWS (index of afterload) decreased significantly with isoflurane-nitrous oxide (n = 10) in concentrations of 1.5-1.95 MAC, but there were no significant changes in LVESWS with halothane-nitrous oxide (n = 10). ⋯ In the analysis of the LVESWS-Vcfc relationship, myocardial contractility associated with isoflurane-nitrous oxide anaesthesia did not differ significantly from that associated with halothane-nitrous oxide anaesthesia at equiMAC concentrations. The results suggest that halothane-nitrous oxide anaesthesia, at 1.5-1.95 MAC, maintained myocardial contractility in similar anaesthetic concentrations to isoflurane-nitrous oxide.
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We have assessed postoperative delirium in 24 patients undergoing thoracotomy for pulmonary malignancy throughout their stay in hospital. Arterial oxygen saturation was measured with a pulse oximeter on the night before operation and on the second night after operation. Five patients (21%) developed clinically significant postoperative delirium, and delirium occurred in all patients who had inadequate oxygenation. ⋯ When patients were delirious, the first treatment of choice was supplementary oxygen and all patients were treated successfully by this simple regimen. In two patients, supplementary treatment with zuclopenthixol 6 mg daily was necessary. We conclude that hypoxaemia may be a contributing factor in postoperative brain dysfunction, as postoperative delirium was associated with hypoxaemia and was treated successfully with supplementary oxygen.